Provider Demographics
NPI:1942020375
Name:COURAGEOUS COUNSELING LLC
Entity type:Organization
Organization Name:COURAGEOUS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:DESORBO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:475-331-9065
Mailing Address - Street 1:41C NEW LONDON TPKE STE 4
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4209
Mailing Address - Country:US
Mailing Address - Phone:475-331-9065
Mailing Address - Fax:
Practice Address - Street 1:41C NEW LONDON TPKE STE 4
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4209
Practice Address - Country:US
Practice Address - Phone:475-331-9065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty